Category: academia

Over the last two years I have been fortunate to work with some real leaders in pharmacy informatics education. One of the most accomplished pioneers in this realm is Dr. Beth Breeden, who is the Director of the Master of Health Care Informatics (MHCI) program at the Lipscomb University College of Pharmacy and Health Sciences in Nashville, TN. Pharmacy students at our University have a rare set of opportunities in informatics education, including a dual pharmacy-informatics program that is the second of its kind in the country. Pharmacy students can choose to concurrently complete a dual PharmD+MHCI or PharmD+Certificate in HCI. We also offer both summer internships and a specialty residency in partnership with Vanderbilt University focused on pharmacy informatics as well as related experiential and research opportunities to our students. It doesn’t hurt that Nashville has evolved into the health care capital of the country. But creating these types of health care informatics opportunities for pharmacy students is a challenge nationally for pharmacy and other health care educators, which is why the article described below was written. Hopefully the framework presented and specific examples described help educators working in even the most resource-challenged environs develop informatics opportunities for their students.

Standards requiring education in informatics in pharmacy curricula were introduced in the last 10 years by the Accreditation Council for Pharmacy Education. Mirroring difficulties faced by other health professions educators, implementation of these requirements remains fragmented and somewhat limited across colleges of pharmacy in the US. Clinical practice and workforce metrics underline a pronounced need for clinicians with varying competencies in health informatics. In response to these challenges, a multitiered health informatics curriculum was developed and implemented at a college of pharmacy in the Southeast. The multitiered approach is structured to ensure that graduating pharmacists possess core competencies in health informatics, while providing specialized and advanced training opportunities for pharmacy students, health professions students, and working professionals interested in a career path in informatics. The approach described herein offers institutions, administrators, faculty, residents, and students an adaptable model for selected or comprehensive adoption and integration of a multitiered health informatics curriculum.

A gentle street poet named Earl Simmons once penned the words, “X Gonna Give It To Ya”. I can’t remember the next line of the stanza, but I think it may have been, “If You Let it”. He may very well have been talking about Stanford Medicine X, because you kind of have to be open to what it has to offer. But if you are, it will deliver quite an experience.

As usual, #MedX started well before the conference proper with the pre-conference which generated an outpouring of tweets and other activities leading up to its kickoff this year and throughout the conference. If there is any doubt, the fine folks at Symplur have put that question to bed.

From the pre-conference, there was a high-utility tweetstream for anyone interested in clinical trial design, particularly those seeking ways to integrate the patient. From afar, it appeared the workshop was very effective in introducing epatients to the complexities and headaches of clinical trial design and execution AND in introducing researchers to what epatients really care and think about with clinical trials.

Mary Meeker from KPCB recently delivered her gallery of “2013 Internet Trends” at the All Things D conference (#D11). I was originally directed to this data marathon from the mobile perspective via Brian Dolan (@mobilehealth). However, Meeker’s presentation is much more than that. It is a sprawling look at the Internet of Things, Traditional Industries Being Re-Imagined, and Sharing Everything. Fortunately, her mammoth 117-slide deck (that was delivered quickly in just 20 minutes; video here) has been placed on @Slideshare.

It is a lot to process, but here are just a few points that jumped out at me from Meeker’s presentation:

The average smartphone user reaches for his/her device 150 times a day (what does this hint at for wearables?)

Since the demand for pharmacy residency spots far outstrips the supply – only about 60% of students match nationally – my colleagues Josh Caballero, PharmD, BCPP and Sandra Benavides, PharmD created a course to better prepare students at our College of Pharmacy to pursue a residency. Over the next couple of years, students completing that course went on to match 80% of the time. That success eventually turned into the recently published book, Get The Residency: ASHP’s Guide to Residency Interviews and Preparation edited by Drs. Caballero, Benavides, and I. The book was written in collaboration with faculty, clinicians, and residency program directors from across the country. I am pleased that it has been well received by students and reviewers alike and has entered its second printing.

Skinny jeans are a surrogate marker, Nick Gross was not who I expected, and the e-patients are even braver than I thought. Listening to the Club Med X play list (selections at bottom), I found myself reflecting on the things I learned, who I spoke with, and what inspired me at Stanford Medicine X.

The Things I Learned
Bringing the science/citizen science
Scientist and wine aficionado Ian Eslick (@ieslick) was the first winner of my daily ‘Bringing the Science’ (BtS) award at Med X. He explained how his own condition of psoriasis informed and affected his approach in creating the first MIT-run authoring experiment. The purpose of the experiment is to study “how patients think about self-experimentation and figuring out how making changes impacts them” at PersonalExperiments.org. He also opened the door to the n-of-1 vs epi debate and the idea of future sampling.

The next day CEO of Asthmapolis David Van Sickle (@dvansickle) claimed the coveted (albeit fictitious) BtS award with his fantastic marriage of humanizing the process of research with almost zealous inquisitiveness. He shared the origin of his obsession of “stalking asthma” from Navajo villages to Alaska and then to the CDC where the limitations of public health data and the role of technology were crystallized for him. Van Sickle went on to describe his excitement about the role of mHealth in preventing diseases in populations. Acknowledging that I may have sipped the Kool-Aid when it moved into mHealth for prevention, you must watch his 15 minute talk. “The hardest cause to identify is the one that is universally distributed.” Indeed.

Rhiju Das was the very next speaker discussing EteRNA, which necessitated creation of the ‘Bringing the Citizen Science’ faux-ward. His Das Group at Stanford in conjunction with Carnegie Mellon challenges citizen scientists and gamers to create RNA sequences that fold into target shapes via the interface they’ve developed. Interestingly, in part due to Das’ involvement as part of the team that created Foldit, EteRNA is seen as its successor by some.

Role of design and UX
So, it turns out design isn’t just for architects and frogs anymore. I had some feel for the roles of human-computer interaction and behavioral health design from working with researchers and others like Tonic. However, I was blown away by the roles of design and UX ranging from the seemingly mundane (e.g., hospital equipment) to the ambitiousness of the IDEO Design Challenge Workshop to its potential in transforming children’s fears about nebulizer treatments into nurturing moments.

Self-trackers and Quantified Self
Before the Med X Self-Tracking Day, I was peripherally aware that people like @FredTrotter were hacking away at things and tweeting their weight and that Ernesto Ramirez (@e_ramirez) was causing waves in something called Quantified Self. But I definitely did not realize how widespread self-tracking is until @SusannahFox debuted her new Pew data (re-defining it for much of the crowd), nor did I appreciate how creative (@nancyhd; Winner: Best smile-powered LED headdress) or dedicated (@bettslacroix) some of those involved are. This is an area worth exploring for future research and I’ll be curious to see what comes of some of the specific efforts such as MyMee.

Who I Spoke WithSurprises and plans
Just because it seems cliché to say that the best part about conferences are often the hallway conversations doesn’t make it any less true. In this case, the Medicine X First Look video archive of the entire conference goes a long way for those who couldn’t make it…but being surrounded by the attendees of this conference conferred an entirely separate set of benefits and opportunities. I had a series of eye-opening impromptu meetings and promising conversations. One was with Nate Gross (he of the minimalist Twitter handle @NG; co-founder of Rock Health and Doximity) at a group dinner. As I have zero feet in the business world and most of my business savvy comes from having watched the movie Wall Street in 1987, I was sort of resigned to sitting next to a brusque, bottom-line type. Instead, I found him to outwardly be a more contemplative sort who spent more time observing than speaking…or maybe he was just happy to be seated next to someone who didn’t have something to pitch.

Most of my other notable conversations portended more specific possibilities. I found myself in one sitdown listening to opportunities described on the fly between AMIA Fellow and researcher Qing Zeng-Treitler, Medify’s Derek Streat, and Alliance Health’s David Goldsmith (@dsgold). Later I enjoyed an intial exploration with Sarah Kucharski (@AfternoonNapper) about extending the role of the patient in research design. That was a conversation I suspect will continue.

What Inspired MeTwo people and an object
Unsurprisingly, it was the people and their stories at Medicine X that I found most inspiring. Many of the Ignite talks by the e-patient scholars were personal and touching, but I found two people particularly so. Sean Ahrens has taken his own story about Crohn’s and literally built a community for others suffering with the same struggles in Crohnology. It’s amazing to me that someone with a potentially debilitating condition refuses to cave to its daily demands and instead sources it to create a virtual bridge to connect and benefit others.

The other person is @DanaMLewis. Personal bias aside (see panel slide deck), to have a person at her age & stage create another type of virtual community in #hcsm that has such far reaching effects that it even inspires Alicia (@stales) Staley (herself quite the wow-inducer) to create #bcsm is immensely encouraging to me.

Youth. Creation. Connection. Wow.

A different kind of enchanted object
Watching David Rose of Vitality present at the mHealth Summit introduced me to the concept of the ‘enchanted object’. At Med X, I saw a more literal version of this implemented in the form of the Magic Mask. The Magic Mask used augmented reality tech and lessons from IDEO to transform what can be a frightening experience of nebulizer treatments to a parent-involved storybook time for these children with asthma. Trust me, you’ll want to read the full description of this work by @RoujaPakiman and @LucieRichter here.

Our Panel and Fin
An e-patient, an entrepreneur, and an academician collaborate to conduct research. In our panel, @DanaMLewis, @BorisGlants, and I tried to share our lessons in adopting the participatory design model for research. Hopefully we were able to inform a bit about misteps and successes and provide a dash of inspiration so that more patients and researchers will partner to capitalize on the strengths of each other.

I have been to a lot of conferences, and no one puts the level of thought and care into each detail of a conference like @LarryChu. This was a stellar experience that I look forward to next year!

TC (Theft Citation i.e., where I stole this post title from): I read @SusannahFox’s post on Stanford Medicine X. As with many of her posts (and I think she would agree), some of the best value is in the comments. In this case, it was the contribution by David Goldsmith who pointed out that Med X is the rarest of birds in that it managed to both inform AND inspire.

As the profession of pharmacy continues to evolve in response to society’s health-related needs, one of the most pressing developments is the demand for more residency training opportunities. The demand currently far outstrips the supply of residency positions, and 2010 saw nearly 1 in 3 applicants fail to secure one through the Match. The onus on us as pharmacy educators is two-fold. Nationally, we need to scale up existing slots and help create new programs. Locally, we need to prepare our students as intensively as possible to help them compete for residencies that will help transform them into agents of change for the profession.

To that end, a couple of my colleagues developed an elective, Residency Interviewing Preparatory Seminar (RIPS), the details of which were recently published in the American Journal of Health-System Pharmacy. I was fortunate to be involved in this course aimed at developing our students’ core skills in the process including: improving their interviewing and presentation skills, professionalism, and developing their curriculum vitae (CV) and personal statement. As the course was targeted to P4s (i.e., completing the final, clinical phase of their education) who were at their rotation site all day, the class was held weekly for two hours in the evening and timed to be completed directly before the Midyear Clinical Meeting.

Completion of the RIPS course demonstrably improved the confidence of the enrolled students and 78% of RIPS students that cycle secured a residency. Nationally, the success rate is only around 62%, although these numbers cannot be directly compared. We have continued the course since publication and the most recent iteration saw a further increase in the percentage of RIPS students able to secure a residency position. Plans are to continue an iterative approach to course development.

When you teach at a University with multiple campuses (in our case, Fort Lauderdale and Palm Beach in Florida and Ponce in Puerto Rico) even with live, interactive videoconferencing – you have to try and figure out ways to connect with your students at different sites. We’ve tried different methods over the years with varying success, but one that worked well early on was the use of an audience response system (aka clickers). This is something I talked about previously in the presentation, “The Science Behind Engaging Students in Class“.

Our recent article in the American Journal of Pharmaceutical Education basically describes our multi-campus implementation and measurement of its impact on student engagement, satisfaction, and opinions about projected use of clickers in other courses. We also touched on related issues, such as clickers’ possible role in helping desensitize communication apprehension in students.

The Consumer Health Informatics & Web 2.0 in Healthcare elective I coordinate for the college of pharmacy wrapped up in December and the ‘votes’ are in about the course. I felt the course went more smoothly this semester and was thrilled to again be able to expertsource several topics by benefiting from guest lecturers. However, the final decision (as always) rests with the students, whose opinions were solicited in the quest to improve the course.

The final exam is an all essay affair (which is not exactly universally popular) and at the end prompted the students to share their opinions on the most and least useful/interesting lectures of the semester along with other feedback.

Based on the comments they wrote, the topics that generated the most traction among students were mHealth and eProfessionalism. Students conveyed they were most intrigued about the potential of mHealth and felt like the issues within eProfessionalism were most personally relevant in their lives. Contributing guest lectures on these topics were leading social media & pharmacy thinker and University of Kentucky professor Jeff Cain (@DrJeffCain) and pediatric endocrinologist-turned-entrepreneur Jen Dyer (@EndoGoddess), who has created an eponymous app. Dr. Cain’s contribution, in particular, may end up having the most longevity of all topics within the course.

However, the most polarizing topic (and lively discussion) was spurred by the guest lecture “Spread the Love, Nothing Else” by Ramin Bastani (@RaminB) of Qpid.me. I first met Ramin at @BJFogg’s excellent Mobile Health @ Stanford. While I wasn’t entirely sure what I thought of the STD-notification idea initially, I certainly believed it would be a great tool to engage students about issues surrounding mHealth, the changing nature of communication via social media, and public health. It was. They were.

The most pharmacy informatics-centric and global perspectives that resonated with students were provided by Jerry Fahrni (@JFahrni) of Talyst and Brent Fox (@Brent_Fox) of Auburn University, respectively. The course (unsurprisingly) is focused on the consumer health subspecialty of informatics, but those students who already are planning a path in pharmacy informatics clearly took to Dr. Fahrni’s lecture.

We are very excited that the Nova Southeastern University College of Pharmacy has officially launched our Center for Consumer Health Informatics Research (CCHIR)! Like all undertakings of this magnitude, it has been in the works for some time and has benefited from tremendous support from many corners – in particular the Chair of the Department of Pharmacy Practice and the Dean of the College of Pharmacy. Below is a presentation outlining some basics about the Center. I look forward to working with its faculty and collaborators and steering the CCHIR toward many great developments in the future.